运用比较治疗学的方法促进T2DM胰岛素治疗决策的最优化

2型糖尿病(T2DM)为内分泌科常见疾病,胰岛素是最主要的治疗药物之一,但胰岛素治疗方法诸多,各种方案的疗效参差不齐.为了促进2型糖尿病治疗决策的最优化,本文通过利用检索国内报道的相关文献,对文献中2型糖尿病的胰岛素治疗方法进行归纳总结,并且运用比较治疗学的研究方法进行比较分析,旨在寻求最有效的治疗方案.     

2型糖尿病胰岛素治疗探讨

过去,人们(包括医护人员)对2型糖尿病的胰岛素治疗存在许多误区。通过糖尿病的流行病学,2型糖尿病的发病机制,早期胰岛素治疗对2型糖尿病的意义,及胰岛素的种类、剂型,和使用方法(包括补充疗法和替代疗法),以及2型糖尿病的治疗现状,来阐述胰岛素治疗对2型糖尿病的必要性。     

2型糖尿病胰岛素治疗探讨

过去,人们(包括医护人员)对2型糖尿病的胰岛素治疗存在许多误区.通过糖尿病的流行病学,2型糖尿病的发病机制,早期胰岛素治疗对2型糖尿病的意义,及胰岛素的种类、剂型,和使用方法(包括补充疗法和替代疗法),以及2型糖尿病的治疗现状,来阐述胰岛素治疗对2型糖尿病的必要性.     

用比较治疗学的观点谈早期2型糖尿病的胰岛素强化治疗

现在越来越多的证据显示短期胰岛素强化治疗可以使血糖接近正常,并明显改善胰岛β细胞功能,但是也有专家认为这种胰岛素治疗的代价比能带来的好处更多。本文运用比较治疗学的观点就这一问题进行了探讨,并强调了胰岛素强化治疗在早期2型糖尿病治疗中的重要意义。     

阿卡波糖、二甲双胍联合胰岛素类似物治疗肥胖糖尿病短期疗效

观察阿卡波糖、二甲双胍联合胰岛素类似物治疗肥胖2型糖尿病的短期疗效。将60例符合标准患者随机分为观察组和对照组各30例,均给予重组甘精胰岛素联合赖脯胰岛素强化治疗控制血糖,观察组同时给予阿卡波糖及二甲双胍口服,出院时进行疗效评价。观察组血糖达标时间、胰岛素用量少于对照组,餐时胰岛素停用比例大于对照组,差异有统计学意义（P＜0．05）;两组患者出院时体重较入院时均有所下降,观察组较对照组体重变化更明显（P＜0．01）。阿卡波糖、二甲双胍联合胰岛素类似物治疗方案,可作为初诊肥胖2型糖尿病治疗的理想方法之一。     

甘精胰岛素注射时段对2型糖尿病患者空腹血糖的影响

比较甘精胰岛素在不同时段注射对2型糖尿病患者空腹血糖的影响。最终选择89例2型糖尿病患者随机分为两组接受甘精胰岛素早餐前（A组,n=46）和夜间睡前（B组,n=43）注射治疗,观察两组患者空腹血糖的变化。结果显示,所有患者使用甘精胰岛素治疗以后,空腹血糖水平较治疗前均有明显下降,具有统计学差异（P均〈0.001）。但B...     

瑞格列奈联合甘精胰岛素治疗2型糖尿病合并慢性肾功能不全疗效观察

探讨甘精胰岛素联合瑞格列奈治疗2型糖尿病合并慢性肾功能不全的疗效.40例2型糖尿病患者采用甘精胰岛素和瑞格列奈联合治疗12周后患者血糖,肾功能和蛋白尿水平较对照组显著下降,治疗效果显著,值得临床推广使用.     

胰岛素抵抗与2型糖尿病关系的新思考

胰岛素抵抗(IR)与2型糖尿病关系密切,对IR的认识,经历了几十年反复的过程,胰岛素抵抗综合征(IRS)的提出使2型糖尿病防治观念发生了根本的转变,提出了2型糖尿病防治新策略:从以降糖治疗为主到全面防治心血管疾病.对IR的认识和IR与2型糖尿病的关系,体现了辩证唯物主义认识论和系统论的观点.     

2型糖尿病一级亲属代谢相关指标分布规律的研究

为了研究2型糖尿病(DM)家系一级亲属的代谢相关指标变化规律,选择55个2型糖尿病家系中糖尿病患者的一级亲属为研究对象,按照糖耐量试验结果分组,比较组间血压、血糖、血脂、C肽、胰岛素等指标。结果显示,2型糖尿病家系一级亲属各组血脂水平的变化差异无显著性,而血糖、胰岛素抵抗等指标差异有显著性。由此得出结论,2型DM家系一级亲属血脂、血糖、血压、胰岛素等指标均有一定程度的异常,且各组间的血糖、血压、胰岛素抵抗等差异显著于血脂水平的变化。     

从2型糖尿病的发病机制谈糖尿病治疗的新策略

2型糖尿病的发病机制主要为胰岛素抵抗与胰岛β细胞分泌功能受损,二者相互依存、相互作用。2型糖尿病的治疗应以减轻胰岛素的抵抗和保护胰岛β细胞为主,以生活方式干预加二甲双胍作为基础治疗,根据不同个体在不同阶段所侧重的不同发病机制,采用联合、综合管理。     

2型糖尿病患者抑郁患病率调查与分析

调查2型糖尿病（T2DM）患者抑郁患病率,探讨影响抑郁发生的因素。从青岛市城区常住居民中随机抽取40岁以上者5000人,选取其中已诊T2DM患者440例,运用Zung抑郁自评量表等进行调查、测定临床生化指标,进行分析。T2DM患者抑郁患病率为21．82％,抑郁对血糖控制不利,病程长、收入低、应用胰岛素、有并发症、不运动、血糖控制差为T2DM患者抑郁患病的危险因素。     

伴家族史的2型糖尿病危险因素的病例对照研究

为探讨2型糖尿病代谢特征及发病的危险因素,选取大连地区91例有家族史的T2DM患者为病例组,以44例患者的配偶（糖耐量正常）为对照组,进行流行病学问卷调查和体格检查,同时测定空腹血糖、空腹胰岛素、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白等指标,采用稳态模型法计算两组的胰岛素抵抗指数和β细胞功能指数,并进行多因素非条件Logistic回归分析。结果显示：TG、腰臀比和Ln（HOMAIR）病例组高于对照组,而Ln（HOMAβ）则病例组低于对照组,均具有统计学意义（P〈0．05）。多因素非条件Logistic回归分析结果提示,影响T2DM发病的因素有心血管疾病史、Ln（HOMAIR）及Ln（HOMAβ）。由此可见T2DM患者存在血脂代谢异常;心血管疾病史和Ln（HOMAIR）为发病的危险因素,Ln（HOMAβ）为保护因素。     

糖尿病的免疫抑制治疗

淡化糖尿病的分型为我们提供了一个全新的思维空间。即传统的1型和至少部分2型糖尿病可能都是一种自身免疫性疾病,而目前流行的炎症学说可能是对认可免疫损伤是糖尿病发病理论的一个过渡,我们应该重新审视糖尿病的早期治疗和研究其慢性并发症的发病机理。我们则采用小别量、长时间的治疗理念,早期接受这种免疫治疗的患者出现低血糖的症状,遂减少胰岛素的剂量;再次出现低血糖,我们就继续减少胰岛素的剂量。结果,有部分患者完全摆脱了胰岛素。我们对糖尿病的再认识是建立在对多脏器活检的基础之上。我们的活检结果表明,糖尿病肾病存在着免疫损伤。糖尿病眼底病变是使患者致盲的主要病因,糖尿病患者的眼底病变是一种自身免疫损伤的结果。我们尝试用小剂量的免疫抑制剂环孢菌素A（25mgbid）治疗糖尿病眼底出血,取得了不错的疗效,也证实糖尿病眼底病变是一种血管炎,与自身免疫病变有关。其他的器官还包括垂体、大脑的血管、糖尿病足、冠心病、皮肤的病变和肌肉活检的免疫组化也均有证据表明,免疫损伤是导致多种慢性并发症的罪魁祸首,是一种多器官免疫损伤的结果无论是1型糖尿病,还是2型糖尿病,肌细胞表面或多或少均有免疫复合物沉积。这些免疫复合物的存在势必会影响胰岛素与肌肉细胞表面的胰岛素受体结合,即胰岛素抵抗的存在。为此,我们在临床上广泛采用了免疫抑制治疗的理念治疗糖尿病。应用小剂量胰岛素和小剂量环孢素A治疗早期发现的糖尿病取得了不错的疗效。唯一担心的副作用发生在肝脏,即部分糖尿病患者会出现总胆红素升高,而也有一部分患者总胆红素不升高。     

2型糖尿病与骨代谢标志物相关性分析

探讨骨代谢标志物与2型糖尿病的相关性。收集2型糖尿病患者50例为糖尿病（T2DM ）组,非糖尿病患者17例为对照组,检测所有研究对象的血清骨代谢标志物、空腹血糖（FBG）、糖化血红蛋白（HbA1c）。与对照组相比,T2DM 组血清25-羟维生素D3（25-OH VitD3）、骨钙素（BGP）、总Ⅰ型胶原氨基端延长肽（TPINP）水平明显下降,β胶原特殊序列（β-CTx）水平升高;血清25-OH VitD3与 HbA1c呈负相关,BGP与 FBG呈负相关,TPINP与 FBG和 HbA1c呈负相关,β-CTx与FBG、HbA1c呈正相关。提示2型糖尿病与骨代谢标志物存在一定的相关性。     

Plasma BDNF is reduced among middle-aged and elderly women with impaired insulin function: Evidence of a compensatory mechanism

Brain-derived neurotrophic factor (BDNF) plays a regulatory role in neuronal differentiation and synaptic plasticity and has been linked to glucose regulation and cognition. Associations among plasma BDNF, cognition, and insulin function were explored. Forty-one participants with impaired insulin function (IIF), ranging from insulin resistance to type 2 diabetes mellitus (T2DM), were matched with 41 healthy controls on gender, age, education, and IQ. Participants received complete medical, neurological, psychiatric, and neuropsychological evaluations. IIF individuals had significantly lower plasma BDNF levels than controls, particularly females, and higher BDNF levels were associated with poorer explicit memory in IIF females, suggesting that higher levels within this group may reflect the body’s efforts to respond to damage. After accounting for age, education, and HbA1c, BDNF significantly predicted 13.1–23.5% of the variance in explicit memory in IIF women. These findings suggest that BDNF elevations within diseased groups may not always be a marker of health.     

Stress and Chronic Illness: the Case of Diabetes

Globally, Type 2 Diabetes Mellitus (T2DM) is one of the most prevalent chronic illnesses. Managing T2DM is a major challenge now affecting the lives of around 200 million people. Even when medication, diet, and physical activity regimens are maintained, blood sugar levels might not be effectively controlled because stress triggers the release of sugar into the blood. This makes the management of stress an important adjunct to the treatment of T2DM. Stress includes both life stress, the major issues that people face in their lives, such as job loss, divorce, or death of a loved one, and daily hassles, smaller everyday problems, such as deadlines for work, traffic hold-ups, or family disagreements. The stress levels created by these events are exacerbated by the stress created by the demands of managing diabetes. In this paper, we first examine the evidence for the relationship between stress and poor blood sugar control in people with T2DM. Then, we consider research that has examined the impact of various stress management strategies on blood sugar level. Finally, we discuss some promising psychological techniques for managing stress that could be helpful for people with diabetes or pre-diabetes. We note the double benefit of physical activity, which directly assists in the metabolism of sugar from the blood and indirectly reduces acute stress and chronic stress reactivity, thus providing a buffer against the effects of stress for people with T2DM.     

糖尿病“达标”教育对控制2型糖尿病的影响

为评价"达标"教育对新诊断2型糖尿病(T2DM)监测及控制水平的影响,选取新诊断T2DM患者90例,随机分为两组,实验组进行"控制目标"认知教育,对照组不进行。治疗6个月后,比较两组控制水平。结果实验组与对照组相比,血糖、血压、体重监测及主动拜访专业医生的频次显著为高,血糖、血压、胆固醇控制显著为好。提示对新诊T2DM患者进行"达标"教育可提高DM监测频次及控制水平。     

Intraindividual Variability of Neuromotor Function Predicts Falls Risk in Older Adults and those with Type 2 Diabetes

This study was designed to examine the effect of increasing age and type 2 diabetes on the average responses and inter- and intraindividual variability of falls risk, reaction time, strength, and walking speed for healthy older adults and older persons with type 2 diabetes (T2DM). Seventy-five older individuals (controls) and 75 persons with T2DM aged between 50 and 79 years participated in the study. Assessments of falls risk, reaction time (RT), knee extension strength, and walking speed were conducted. The results revealed that advancing age for both control and T2DM groups was reflected by a progressive increase in falls risk, decreased leg strength and a decline (i.e., slowing) of reactions and gait speed. Conversely, the level of intraindividual variability for the RT, strength and gait measures increased with increasing age for both groups, with T2DM persons tending to be more variable compared to the healthy controls of similar age. In contrast to the intraindividual changes, measures of interindividual variability revealed few differences between the healthy elderly and T2DM individuals. Taken together, the findings support the proposition that intraindividual variability of neuromotor measures may be useful as a biomarker for the early detection of decline in physiological function due to age or disease.     

多因素强化干预对2型糖尿病患者低脂联素血症的影响

探讨多因素强化干预对2型糖尿病患者低脂联素血症的影响。89例2型糖尿病患者实施血糖、血脂、血压强化控制,随诊1年并检测相关指标变化,统计学分析显示多因素强化干预可改善低脂联素血症,糖化血红蛋白和甘油三酯的变化值是影响血清脂联素水平变化的主要因素。因此,多因素强化干预可以有效改善低脂联素血症,可能减低糖尿病并发症发生的风险。